Hepatitis C surge in central Ohio may spur needle-exchange program

Misti Crane, The Columbus Dispatch

Monday

Jul 6, 2015 at 12:01 AMJul 6, 2015 at 7:09 AM

The boom in heroin use paired with a surge in hepatitis C infections in Franklin County and across Ohio have heightened worries about the spread of other diseases, particularly HIV, and sparked conversations about a local needle exchange. Hepatitis C, a treatable but sometimes deadly viral disease that attacks the liver, was diagnosed in 719 people in Franklin County five years ago. The number had nearly doubled by last year, to 1,369, according to data from Columbus Public Health.

The boom in heroin use paired with a surge in hepatitis C infections in Franklin County and across Ohio have heightened worries about the spread of other diseases, particularly HIV, and sparked conversations about a local needle exchange.

Hepatitis C, a treatable but sometimes deadly viral disease that attacks the liver, was diagnosed in 719 people in Franklin County five years ago. The number had nearly doubled by last year, to 1,369, according to data from Columbus Public Health. So far this year, the county is on pace to record more than 1,400 cases. In just one year, the number of hepatitis C cases statewide grew from 10,020 in 2013 to 15,887 in 2014.

Some of that most certainly is due to a push for testing at-risk baby boomers that has been fueled by better treatments. But there’s little question among doctors and public-health leaders that needle-sharing by people using heroin and other drugs is playing a role. Last year, 603 of the cases in Franklin County were in people 34 or younger.

The Ohio Department of Health reported this year that heroin-related deaths increased statewide from 697 in 2012 to 983 in 2013, surpassing prescription-drug deaths. In 2013, there were 197 drug-overdose deaths (including from heroin and pills) in Franklin County, up from 63 a decade before, state data show.

There are a handful of needle-exchange programs in Ohio that aim to prevent illness and engage people who could benefit from other services, including counseling.

Under current Ohio law, a community has to declare an emergency before offering clean needles. That has never happened in Columbus, primarily because the city’s HIV burden could be linked mostly to sex, not intravenous drugs, said Columbus Health Commissioner Dr. Teresa Long.

Long and others are discussing how to start a comprehensive program here to address heroin use and disease that could include a needle exchange, she said last week. There is no formal plan.

“We are learning about it. We are interested in anything that would protect people,” she said. “ We are interested in considering all the options.”

Long said one area that interests her is increasing the distribution of naloxone (sold as Narcan), a drug that can save heroin and other opioid users from a fatal overdose. It already is being used in Franklin County, but there is more opportunity to get it into the right hands, Long said.

Coupling needle exchange with access to treatment has proved successful elsewhere, she said.

Long’s mind also is on Indiana, where intravenous drug use and shared needles have led to the largest outbreak of HIV in that state’s history and have HIV doctors and advocates nationwide on alert.

“There is genuine concern over the number of overdoses that are happening, over seeing things like what happened in Indiana and knowing that syringe exchange has the potential to combat that,” said Tania Peterson, director of prevention at AIDS Resource Center Ohio.

Cleveland, Cincinnati, Portsmouth and Dayton have needle-exchange programs. Dayton’s, which is operated by the combined city and county health department, started in April after health officials, law-enforcement agencies and others became alarmed by overdose-death numbers that jumped from 127 in 2010 to 264 last year.

Peterson’s group worked with officials in Montgomery County and is eager to see similar efforts elsewhere, including in Columbus, she said.

Jeff Cooper, health commissioner at Public Health — Dayton & Montgomery County, said the once-a-week exchange program there, called CarePoint, had seen 43 clients and exchanged 650 needles as of late last month.

Two people have entered treatment, and one has finished, based on the program’s referral.

“It’s too soon to determine the long-term implications. ... We know that it’s going to take some time,” said Cooper, who emphasized the importance of having a program that helps people with a multitude of services and doesn’t simply exchange needles.

He said the department budgeted $40,000 for the program’s first year and has met no resistance.

CarePoint refers users to drug-treatment and mental-health agencies and provides condoms and sexual-health education, pregnancy testing and help enrolling in Medicaid. It refers people to housing authorities and food pantries, too.

Long said an effective program here would be one that also takes a comprehensive approach.

From where she sits, family physician Dr. Krisanna Deppen said she’d love to see a local intravenous-drug program, including one offering clean needles.

“I’ve been working with a small group of folks who’ve been advocating for that,” Deppen said. “ Indiana is weighing heavily on these people’s minds.”

She said she sees many pregnant drug users in her family practice in Grove City and at a Nationwide Children’s Hospital clinic. About 30 to 40?percent of them have hepatitis C, which they can pass to their babies.

“It’s good that we don’t have pill mills, but as people have gone from pills to injecting heroin, we’ve seen a lot of things, and hepatitis C is one of them,” Deppen said.

mcrane@dispatch.com

@MistiCrane

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